tbuckley/cabot-search huggingface dataset:
Abstract 13504: The New Cigarette? Cannabis Use as a Potential Risk Factor for Acute Coronary Syndrome
Authors: Abbas Alshami, Steven Douedi, Luz Ramirez, Abdulrahman Museedi, Najia Hussaini, Hani Douedi, Joseph Varon
Journal: Circulation (2022)

Introduction: With new legislation becoming more lenient regulating recreational cannabis use in the United States, the prevalence of cannabis has doubled since 2002 and continues to rise. While there have been some reports of the benefits of cannabis, medical literature has identified several adverse cardiovascular events. Cannabis as a significant risk factor for the acute coronary syndrome (ACS) has been suspected to be attributed to vascular inflammation and platelet activation as well as elevation in heart rate and blood pressure through sympathetic stimulation. Methods: We conducted a case-control study utilizing the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2019 database to investigate hospitalizations for patients aged 18 years old or older with the primary diagnosis of ACS. Comorbidities were identified through their international classification of diseases, 10th revision (ICD-10 codes) recorded in the discharge record for each hospitalization. Records having cocaine or other stimulants were excluded. An alpha (p) value less than 0.05 was considered statistically significant. Results: Of the 34,948,093 records included in the study, 225,275 had a primary diagnosis of ACS, and 767,525 had evidence of cannabis use. The rate of cannabis use in the ACS group (2%, n= 4,490) was lower than the non-ACS group (2.2%, n=763,035, p&lt;0.001), while the rate of smoking was higher in the ACS group [49.5% (n=111,405) vs 31.2% (n=10,840,496), p&lt;0.001] . However, after adjusting for other cardiovascular risk factors in a multivariable logistic regression model, the odds of cannabis use were comparable to smoking (Table 1). Conclusions: In this retrospective case-control study, the odds of cannabis use were similar to the odds of smoking in the records with a primary admission diagnosis of ACS, highlighting cannabis as a strong potential cardiovascular risk factor. Prospective cohort studies are warranted to establish the causality.
Abstract 12855: Matrin-3 Deficiency Exacerbates Hepatic Steatosis and Acute Phase Response
Authors: Xiao Cheng, Vijaya B Baki, Matthew Moran, Qingsheng Li, Xinghui Sun
Journal: Circulation (2022)

Introduction: Nonalcoholic fatty liver disease (NAFLD) has become the most common liver disease worldwide. NAFLD patients have an increased risk of cardiovascular disease. Matrin-3 is a DNA- and RNA-binding protein, and its mutation causes amyotrophic lateral sclerosis in humans. Among these patients, 76% have hepatic steatosis. However, the role of matrin-3 in NAFLD has not been previously studied. Methods and Results: We found that matrin-3 expression is induced in fatty livers of humans and mice. Matrin-3 liver specific knockout mice (LKO) displayed increased levels of plasma triglycerides compared with matrin-3 floxed mice, while the body weights of the two groups of mice are similar after 16-week high-fat diet. Moreover, histological staining and triglyceride assay revealed that LKO mice had a 1.57- and 1.58-fold increase in hepatic lipid area and triglyceride levels, respectively, which associate with an increased liver/body weight ratio. Transcriptome and bioinformatics analysis identified 622 differentially expressed genes in LKO livers. Among them, 142 are target genes of constitutive androstane receptor (CAR), a transcription factor controlling the expression of many genes involved in xenobiotic and lipid metabolism. We also found that the expression of CAR and many CAR target genes was reduced in LKO livers. These data suggest that matrin-3 is important in CAR expression and matrin-3 knockout impairs CAR signaling. Interestingly, matrin-3 LKO mice had increased acute phase response and levels of phosphorylated Stat3 in the livers, indicating increased liver injury and inflammation. Mechanistically, impaired CAR signaling reversed the suppression of Plin2, Plin3, and Plin5 proteins that stabilize lipid droplet and inhibit lipolysis, and it reversed the suppression of interleukin 1 receptor type 1 that activates Stat3 signaling in LKO livers. Lastly, CAR expression positively correlates with matrin-3 expression in human livers (r=0.85, P =0.0002, n=13). Conclusion: matrin-3-CAR axis is an important mechanism to maintain lipid homeostasis and limit acute phase response in fatty livers. It can be potentially targeted to ameliorate hepatic steatosis and inflammation and reduce the risk of cardiovascular disease in NAFLD patients.
Abstract 13880: Outcomes in Pregnant Women Hospitalized With Acute COVID-19 Infection
Authors: Rina Mauricio, Sonia Shah, Kavisha Singh, Monika Sanghavi, Jamie Morgan, Emily Adhikari, Colby Ayers, Erin D Michos, James A De Lemos, Sandeep R Das
Journal: Circulation (2022)

Introduction: There are conflicting data on COVID-19 outcomes in pregnant women. Using the AHA COVID-19 CVD Registry we evaluated COVID-19 outcomes in pregnant vs non-pregnant women with COVID-19. Methods: Women 18-40 years old hospitalized from March 2020 to December 2021 with symptomatic COVID-19 were included (n=2,068), with 110 (5.3%) pregnant at admission. Women with unknown pregnancy status were excluded. Vaccine data were limited (2.8% of participants), therefore omitted from analysis. Baseline demographics and symptoms at presentation were compared between pregnant and non-pregnant women (Table). Rates of death, mechanical ventilation, ICU admission, hospital stay ≥5 days, myocardial infarction, stroke, DVT, PE, and a composite of all outcomes were determined. Multivariable Cox regression analyses were performed, adjusting for comorbidities and prior CVD. Results: Pregnant women hospitalized with COVID-19 had fewer comorbidities than non-pregnant women (Table). There were no deaths in the pregnant group and 44 (2.3%) in the non-pregnant group. Fewer pregnant women were hospitalized ≥5 days (29.1% vs 41.2% non-pregnant); this difference was not statistically significant after multivariable adjustment [adjusted HR (95% CI), 0.67 (0.43-1.02)]. There were no significant differences between the groups in the composite outcome [adjusted HR (95% CI), 0.72 (0.48-1.07)] or its components (Table). Conclusions: Pregnant women hospitalized with symptomatic COVID-19 had fewer comorbidities compared with non-pregnant women. There were fewer deaths and lower rates of hospitalization ≥5 days in pregnant vs non-pregnant women which was no longer statistically significant after multivariable adjustment. The potential for residual confounding due to healthier pregnant women presenting with milder COVID-19 illness or being admitted for non-COVID-19 indications compared to non-pregnant women must be considered when interpreting these findings.
Abstract 13115: Impact of Socioeconomic Status and Remoteness of Residence on Access to Cardiac Care for Pediatric Heart Disease in Alberta, a Jurisdiction of Universal and Centralized Cardiac Healthcare
Authors: Lisa K Hornberger, Christopher Smith, Doug C Dover, Andrew S Mackie, Padma Kaul, Jennifer Conway
Journal: Circulation (2022)

Introduction: Socioeconomic status (SES) and remoteness of residence (RoR) impact access to care and outcomes in congenital (CHD) and acquired (AHD) pediatric heart disease. Whether the universal, centralized Canadian healthcare system mitigates such inequities is unclear. We examined associations between SES and RoR on age at cardiac diagnosis (ACD), time to first intervention (TFI), and annual primary care (PCV) and cardiology (CV) visits as evidence of healthcare access in Alberta. Methods: All children born and diagnosed in Alberta with CHD or AHD from 2005-2017 were included. CHD was classified as mild, moderate, and severe base on the Bethesda Task Force definitions. Geospatial modelling was used to determine drive times (&lt;60, 60-180, &gt;180 minutes) to 1 of 2 provincial cardiac programs. Cox proportional hazards regression models were used to examine relationships between RoR and SES with ACD and TFI, and Poisson models using generalized estimating equations for annual PCV and CV. Results: Of 12,542 children, 9347 had mild, 1733 moderate and 717 severe CHD and 745 AHD. Most (8,833, 70.4%) lived &lt;60 minutes to a cardiac center, and the largest proportion were in SES quintile 1 (least vulnerable, 3,074, 24.5%) and smallest in quintile 5 (most vulnerable, 2003, 16.0%). Median ACD was 1(IQR 0-108) days for mild, 0(0-54) days for moderate, and 0(0-0) days for severe CHD, and 340(41-1312) days for AHD. Intervention occurred in 1086(62.7%) with moderate CHD (TFI 63(7-150) days), 588(82.0%) with severe CHD (11(5-58) days), and 42 with AHD (1828(793-2866) days). ACD was impacted slightly by SES and only in AHD (Table). TFI and PCVs were not impacted by RoR or SES. Finally, CVs were inversely related to RoR for CHD and AHD. Conclusions: In Alberta, SES and RoR do not importantly impact ACD, TFI and PCVs among CHD and AHD patients. Greater RoR but not SES, however, is associated with fewer annual CVs, suggesting a need to optimize cardiac outreach services.
Abstract 13932: Association of Heparin Exposure With 5-year Mortality and Heart Failure in Patients With End-Stage Kidney Disease on Hemodialysis
Authors: Alec Miller, Mark Jacobs, Sobia Khan, Sandeep Mallipattu, Andreas P Kalogeropoulos
Journal: Circulation (2022)

Introduction: Fibroblast growth factor (FGF) 23 is strongly upregulated in end-stage renal disease (ESRD) on dialysis and induces left ventricular hypertrophy (LVH) through activation of cardiac FGF receptor 4. Recent experimental animal data suggest that heparin acts as a co-receptor for FGF23, promoting binding to cardiac cells and LVH. Hypothesis We hypothesized that mortality and HF risk would be higher among patients with ESRD on hemodialysis who are regularly exposed to heparin during dialysis sessions. Methods: Using data from the TriNetX Research Network, we identified patients with ESRD (ICD-10 code N18.6) who received dialysis services (Z49.X) or were dependent on dialysis (Z99.2), for ≥5 instances 1 month apart, during years 2011-2017. Patients were stratified by heparin exposure during dialysis (≥5 instances vs. no exposure). Patients on peritoneal dialysis were excluded. We examined 5-year mortality and HF risk, after matching for demographics, background conditions, laboratory values, and vital signs at baseline. We used Kaplan-Meier estimates for incidence and Cox proportional hazards models for hazard ratios. Results: We matched 2131 patients who were exposed to heparin (≥5 instances) during dialysis and 2131 who were not. The two cohorts were balanced for characteristics, as evident from standardize mean differences &lt;0.1, Table 1. Kaplan-Meier mortality at 5 years was 44.4% in the heparin-exposed cohort vs. 31.4% in the non-exposed cohort (HR 1.39, 95%CI 1.24-1.55; P&lt;0.001). Incidence of HF at 5 years was also higher with heparin exposure: 44.3% vs. 34.0% in the non-exposed cohort (HR 1.35, 95% CI 1.17-1.5; P&lt;0.001). Conclusion In this comparative retrospective study of propensity score matched patients with ESRD on dialysis, regular exposure to heparin was associated with higher mortality and HF risk at 5 years. Despite the shortcomings of a retrospective study, these hypothesis-generating findings merit investigation in prospective studies.
Abstract 13671: Predicting the Coronary Thrombosis Events Risk in Chinese Patients After Percutaneous Coronary Intervention With Drug Eluting Stents: Risk Model From PROMISE Trial
Authors: Ying Song, Jingjing Xu, Lin Jiang, Xueyan Zhao, Fangchao Liu, Zheng Zhang, Yongzhen Zhang, Shuhong Su, Xiaogang Guo, Qingsheng Wang, Yingqing Feng, Zhenyu Liu, Runlin Gao, Han Yaling, Jinqing Yuan
Journal: Circulation (2022)

Introduction: The accurate assessment of individual risk can be of great value to facilitate the prevention of recurrent coronary thrombosis events (CTEs) in patients after percutaneous coronary intervention (PCI) with Drug-Eluting Stents (DES). However, current prediction models in common use were often formulated in white populations and were of limit predicting value in Chinese patients. The current study is aimed at developing and validating a prediction model for recurrent CTEs from 2 contemporary Chinese cohorts of patients after PCI with DES. We formulated a CTEs prediction model from PROMISE trial, a PR ospective O bservational M ulticenter cohort of I schemic and h E morrage risk after PCI. Hypothesis We assessed the hypothesis that the PROMISE model was an effective tool for predicting 2-year CTEs risk in Chinese patients after PCI with DES. Methods 7998 Chinese patients underwent DES-PCI from PROMISE trial with 2-year follow up were used as the derivation cohort to develop the PROMISE model. The external validation was evaluated in one independent Chinese cohort with 3824 participants. Cardiac death, myocardial infarction, definite and probable in-stent thrombosis were defined as CETs. We compared candidate variables between CETs and non-CETs groups. Backward selection with an entry criterion of p&lt;0.05 were used to formulate the model. The model performance was assessed by discrimination C statistics and calibration χ2. We also assessed the internal and external validation. Results Over 2-year follow up in the derivation cohort, 151 patients developed CTEs. Five variables including, previous revascularization, baseline elevated cTNI, left ventricular ejection fraction, residual SYNTAX score after PCI and estimated glomerular filtration rate were finally involved in the PROMISE model. The C statistics of the model was 0.750(95% confidence interval, 0.700-0.799), and the calibration χ2 was 7.2(p=0.612). In the subsequent external validation, the PROMISE model had C statistics of 0.607 (95%CI,0.508-0.706) , and the calibration χ2 was 14.0(p=0.121). Conclusion The PROMISE model had a good internal validation and moderate external validation and it was an effective tool for 2-year CTEs risk prediction in Chinese patients after PCI with DES.
Abstract 14079: Association Between Serum Uric Acid Level and Metabolic Syndrome in a Rural Japanese Population: A Multi-Center Study
Authors: Hiroshi Kobatake, Shinsuke Mikami, AYANO OSAWA, Mirai Kinoshita, Yu Harada, Kouichi Tanaka, Yukiko Nakano
Journal: Circulation (2022)

Introduction: Several reports have showed associations between serum uric acid (UA) levels and metabolic syndrome (MetS). Limited information, however, is available concerning the prospective relation between UA and the risk of developing MetS. Hypothesis: Hyperuricemia would be related to higher odds for MetS in a rural Japanese population. Methods: We evaluated 2406 subjects (1275 male subjects, 1131 female subjects; mean age 49.9 years) who underwent health examination programs in 2008 and 2013, who were free of MetS in 2008. We conducted this multi-center study in two hospitals located in northern Hiroshima prefecture. Results: At baseline, hyperuricemia was detected in 258 male subjects (20%) and 41 female subjects (3.6%). Subjects with hyperuricemia at baseline had significantly higher MetS prevalence in 2013 than those without (male subjects: 14.7% vs. 9.1%, P=0.01; female subjects: 9.8% vs. 1.7%, P=0.008). Compared with subjects in the first quartile of uric acid levels at baseline, the age-adjusted odds ratios (ORs) for cumulative incidence of MetS among subjects in the second, third, and fourth quartile were, 0.77 (95% confidence interval (CI), 0.40-1.48; P=0.43), 1.79 (95% CI, 1.05-3.06; P=0.03) and 2.17 (95% CI, 1.28-3.70; P=0.004), for male subjects. Compared with subjects in the second quartile of uric acid levels at baseline, the age-adjusted ORs for cumulative incidence of MetS among subjects in the third, and fourth quartile were 2.46 (95% CI, 0.47-12.9; P=0.29), 7.34 (95% CI, 1.65-32.6; P=0.009), for female subjects. Multivariable logistic analysis revealed that hyperuricemia was significantly associated with cumulative incidence of MetS in male and more significantly in female subjects (male: OR, 1.79 [95% CI, 1.19-2.69; P=0.005], female: OR, 6.34 [95% CI, 2.03-20.0; P=0.002]). Conclusions: Hyperuricemia is a significant predictor of MetS in rural Japanese population and more significantly in female.
Abstract 14056: The Presence of Very Low QRS Voltage in Multiple Frontal Leads is a Powerful Predictor of Recurrent Neurally Mediated Syncope
Authors: Calina P Schiop-Tentea, Giorgia Coseriu, Lorena Mocanu, Csilla Andrea A Eotvos, Iulia G Zehan, Adriana D Porca, Mihai G Andrei, Roxana M Chiorescu, Sorin Pop, Dan Blendea
Journal: Circulation (2022)

Introduction: Isolated very low QRS voltage (VLV; ≤ 0.3mV) on frontal leads on the electrocardiogram (ECG) has been shown to predict recurrence of neurally mediated syncope (NMS). In most patients VLV occurs in only one isolated ECG lead, however a small number of patients have ≥ 2 leads with VLV (Figure A), the significance of this pattern being unknown. Hypothesis: The aim of the study was to explore the potential relationship between the number of frontal leads with VLV and NMS recurrence. Methods: We included 268 patients with NMS (age 48±20 years, 150 women), with a median of 3 syncopal episodes who were followed for a median of 12 months. Results: Very low voltage was present in one frontal lead in 98 patients (37%), in 2 leads in 16 patients (6%), and in 3 leads in 1 patient (0.4%). Patients with VLV in multiple frontal leads had significantly smaller left ventricular end diastolic diameter (LVEDD) and left ventricular systolic diameter (LVESD) than patients with no VLV (42.8±3.9mm vs. 45.6±5.2mm; p = 0.029, and 27.7±3.9mm vs. 30.3±5.0mm; p = 0.049, respectively). During follow-up 69 patients (26%) experienced recurrent syncope. The actuarial total syncope recurrence rate increased progressively with the number of frontal leads displaying VLV (log rank test chi 2 =34.78; p &lt; 0.0001; Figure B). Multiple frontal leads with VLV was associated with a relative risk of syncope recurrence of 5.5 in univariate analysis. Multivariate Cox regression revealed that the number of frontal leads displaying VLV predicted recurrent syncope (HR 1.83, 95%CI 1.28-2.62) in a model that included history of presyncope and syncope (HR 3.43, 95%CI 1.77-6.65) and LVEDD (HR 0.94, 95%CI 0.89-0.99). Conclusions: Very low voltage in multiple frontal leads is rare. If this pattern occurs, it is associated with a high risk of recurrent NMS. This phenomenon, which appears to be related at least partially to a smaller LV cavity size, may help generate new diagnostic tools and insights into the pathogenesis of NMS.
Abstract 13430: Arterial Health After Preeclampsia: Role of Chronic Hypertension
Authors: Amelie Paquin, Ana Werlang, Thais Coutinho
Journal: Circulation (2022)

Introduction: Preeclampsia (PE) is associated with an increased cardiovascular (CV) risk. Recent data have shown worse left ventricular remodeling and diastolic function in women with PE and persistent hypertension (HTN). To improve our understanding of CV risk after PE, we evaluated the contribution of persistent HTN on arterial health. Methods: We recruited 40 women with PE history and 40 age-matched women with normotensive pregnancies (6 months - 6 years post-partum). We comprehensively evaluated measures of arterial health and hemodynamics with validated technique combining applanation tonometry and transthoracic echocardiography. We compared 3 groups: previous PE with persistent HTN (PE-HTN), previous PE with normalized blood pressure (PE-noHTN) and controls. Associations of PE-HTN with arterial health measures were assessed with multivariable linear regression adjusted for age, BSA, heart rate, diabetes, smoking history, serum creatinine and parity. Results: Eight (20%) of the post-PE women had persistent HTN. Mean age was 35.8 ± 3.9 years, number of pregnancies was 2.4 ± 1.4, and time since last pregnancy was 2.6 ± 1.2 years, and not different across the 3 groups (P&lt;0.05 for each). Results of the multivariable linear regression models are summarized in the Figure, demonstrating that women with PE-HTN had significantly higher aortic stiffness, wave reflections, pulsatile and steady arterial load than controls. Among women with previous PE whose blood pressure normalized postpartum, arterial stiffness, wave reflections and steady arterial load were also worse compared to controls, albeit with smaller effect size (p&lt;0.05). Conclusions: This is the first study to demonstrate the contribution of persistent HTN on worse arterial health following PE. Since measures of arterial health are associated with CV events in the population, women with PE-HTN may represent a higher risk subgroup who could benefit from targeted primary prevention strategies.
Abstract 14234: A Long-Standing Instance of Undiagnosed Misplaced Pacemaker Lead
Authors: Aangi J Shah, Muhammad O Zaman, Joseph F McHale, NACHIKET MADHAV APTE
Journal: Circulation (2022)

Introduction: Misplacement of pacemaker (PCM) lead into the left ventricle (LV) is a rare complication with an incidence of 0.34%. Limited cases of long-standing misplaced leads have been reported in the past. We present a case of misplaced PCM lead in the LV that went undiagnosed for 10 years, complicated by thrombotic strokes. Case information:62-year-old male with history of sick sinus syndrome and a dual chamber PCM implantation, and thrombotic strokes with residual neurological deficits while on warfarin, presented to our hospital with gastrointestinal bleeding, subdural hematoma, and pulmonary embolism, in the setting of a mechanical fall. The patient had undergone a PCM implantation 10 years ago, and had a recent generator change 6 months prior to his presentation. Diagnosis: Chest X-ray on admission was suggestive of misplaced PCM lead in the LV which was later confirmed by transesophageal echocardiography, that showed PCM lead attached to the postero-lateral wall of the LV. Management: Given the patient’s complex presentation, a multi-disciplinary team approach was pursued. The patient was cautiously challenged with heparin drip with simultaneous serial hemoglobin and repeat CT head monitoring. The misplaced lead was determined as the likely culprit for the recurrent strokes. Since percutaneous lead extraction posed a high risk of complications, surgical correction was performed. The patient subsequently underwent a successful percutaneous dual chamber PCM implantation with His bundle pacing. Conclusion: Our case highlights a long-standing instance of misplaced PCM lead and consequent recurrent thrombotic strokes. We chose surgical correction over of percutaneous extraction given high risk of LV rupture and systemic thromboembolism with lead traction.